China is following a strategy of shutting down everything and getting R0 as low as possible. This works well in the short term, but they either have to keep everything shut down forever, or risk the whole thing starting over again.

UK is following a strategy of shutting down only the highest-risk people, and letting the infection burn itself out. It's a permanent solution, but it's going to be really awful for a while as the hospitals overload and many people die from lack of hospital care.

What about a strategy in between these two? Shut everything down, then gradually unshut down a little bit at a time. Your goal is to "surf" the border of the number of cases your medical system can handle at any given time (maybe this would mean an R0 of 1?) Any more cases, and you tighten quarantine; any fewer cases, and you relax it. If you're really organized, you can say things like "This is the month for people with last names A - F to go out and get the coronavirus". That way you never get extra mortality from the medical system being overloaded, but you do eventually get herd immunity and the ability to return to normalcy.

This would be sacrificing a certain number of lives, so you'd only want to do it if you were sure that you couldn't make the virus disappear entirely, and sure that there wasn't going to be vaccine or something in a few months that would solve the problem, but it seems like more long-term thinking than anything I've heard so far.

I've never heard of anyone trying anything like this before, but maybe there's never been a relevant situation before.

Update: the positions are now filled. See here for the official announcement.

Help wanted: pandemic.metaculus.com project lead

The high interest and proliferation of questions on the novel coronavirus calls for dedicated attention, which led to the formation of pandemic.metaculus.com. Managing it, though, is straining Metaculus's very limited staff and community moderator team. Contingent on acquisition of funding (which Metaculus is working to secure), Metaculus is looking to bring onboard someone to help manage this project. Components would include:

• Managing the pandemic site and question series as a sort of "editor in chief" working with the community moderators (as Tamay does now for Metaculus in general.)
• Helping build data products and analyses out of the questions and results.

The above indicates a range of skills including pretty strong understanding of Metaculus, and data analysis capability. Science background would be great, and huge bonus for actual medical knowledge. This is probably a part-time role but full-ish time is also imaginable depending upon the person, the duration, and funding.

If you're interested, please send a note and CV to jobs@metaculus.com.

If this news article is accurate, masks will not be scarce for much longer. That article claims that China is now producing masks at 116M/day, a 12x increase compared to the start of February (5 weeks ago), and that they will export them. This is in addition to mask production in other countries.

I  am not sure whether, when combined with production in other countries, this satisfies the entire world demand. But masks aren't complicated objects and aren't made of scarce materials, and this is pretty strong evidence that production can be scaled up even further, if necessary.

In a few weeks, a number of public figures may find themselves doing an awkward about-face from "masks don't work and no one should wear them" to "masks do work and they are mandatory".

(If you are able to buy masks for less than $1/each through ordinary channels, it means the shortage has abated, and you can buy them without worrying about depriving health care workers of those supplies, but you shouldn't stock up on more than you need in the short term until the price has been low for at least a few weeks.)

I heard a rumor of someone in the Bay area claiming to work in the intelligence community, to be terminally ill, and to have received an experimental COVID-19 vaccine. I think this rumor is false with respect to the specific person, but do note that "military officers with preexisting terminal illnesses who volunteer" is a group that may actually exist, and that at least one drug company claims to have shipped vaccines for a phase 1 trial on Feb 24.

This raises the question: if you're well resourced, desperate, competent, and in possession of expendable military volunteers, how long does development for a vaccine actually take?

Given a candidate vaccine, you need to do three things: find out if confers immunity (and how much immunity), find out if it causes side effects severe enough to not be worth it, and scale up production.

All three of these can be done in parallel. If you have expendable volunteers, you don't need to start with an animal model; you can just give them the vaccine, and see whether they suffer side effects. Testing efficacy can be done in parallel, with the same volunteers, and takes about three weeks--you give the vaccine, wait a week, expose to virus, then wait in quarantine for two weeks.

If you're unlucky, this kills all the test subjects. If you're average-lucky, your test subjects get COVID-19 and die at the same rate as people die of that. If you're lucky, you have solid evidence of effectiveness and moderate evidence of safety. Not as much evidence of safety as you want, and certainly not up to the FDA's traditional standards, but good enough that medical workers in affected areas would seriously consider it.

Maybe it's optimistic, but in my model of the world, there are islands of competence within the intelligence community which do things like this. In most worlds, this project fails, and the public never hears about it. The President, on the other hand, does hear about it. He hears about many vaccine projects with different timelines and different chances of success, and they all blend together. He says on the news that a vaccine will be ready in several weeks, and everyone--the NIAID, the press, the public--mocks him for the mistake, because they don't know about the secret trial. Or maybe he never heard of anything like that, and is just confused; this is not something we are likely to ever know.

Coronavirus could spread unabated, or it could be killed by quarantines, or it could spread but lose its lethality to a new treatment, or we could be surprised by an unprecedentedly fast vaccine. Let us retain our flexibility, and keep our prediction confidence intervals wide.

Are the economic forecasts still too sunny?

(Warning: Long comment)

Two weeks ago Wei Dai released his financial statement [LW(p) · GW(p)] on his bet that the coronavirus would negatively impact the stock market. Since then (at the time of writing) the S&P has dropped another 9%. This move has been considered by [LW · GW] many [LW · GW] to be definitive evidence against the efficient market hypothesis, given that the epistemic situation with respect to the coronavirus has apparently not changed much in weeks (at least to a first approximation).

One hypothesis for why the stock market reacted as it did seems to be that people are failing to take exponential growth of the virus into account, and thus make overly optimistic predictions. This parallels Ray Kurzweil's observations of how people view technological progress,

When people think of a future period, they intuitively assume that the current rate of progress will continue for future periods. However, careful consideration of the pace of technology shows that the rate of progress is not constant, but it is human nature to adapt to the changing pace, so the intuitive view is that the pace will continue at the current rate. [...] From the mathematician’s perspective, a primary reason for this is that an exponential curve approximates a straight line when viewed for a brief duration.

The idea that smart investors don't understand exponential curves is absurd on its face, so another hypothesis is that people were afraid to "ring the alarm bell" about the virus, since no one else was ringing it at the time.

Determining which of the above hypotheses is true is important for determining whether you expect the market to continue declining. To see why, consider that if the "alarm bell" hypothesis was true, you might expect that now that the alarm bell has been set off, you now have no epistemic advantage over the market. The efficient market is thus reset. Nonetheless, the alarm bell might be a gradient, and therefore it could be that more people have yet to ring it. And of course both hypotheses might have some grain of truth.

Now that the market has dropped another 9%, the question on every investor's mind is, will it drop further? Yet, if the efficient market has really been debunked, then answering this question should be doable -- and I minimally attempt to do so here.

The approach I take in this post is to analyze the working assumptions of the most recent economic forecasts I could find, ie. try to determine what conditions they expect, which lead to their predictions. If I find these working assumptions to underestimate the virus' impact based on my best estimates, then I conclude, very tentatively, that the forecast is still too sunny. Otherwise, I conclude that the alarm bell has been rung. Overall, there are no fast and easy conclusions here.

The main issue is that this crisis has unfolded far too quickly for many up-to-date forecasts to come out. Still, I find a few that may help in my inquiry.

Disclaimer: I am in no position to offer specific financial advice to anyone, and I write this post for informational purposes only. I have no expertise in finance, and I am not creating this post to be authoritative. Please do not cite this post as proof that everyone should do some action X.

My Parameters

I offer the following predictions about particular parameters of the virus. I admit that many of my parameters are probably wrong. But at the same time, I make a stronger claim that no one else really has a much better idea of what they are talking about. Of course, I gladly welcome people to critique my estimates here.

• I expect that the coronavirus will infect at least a few hundred million people by 1/1/2022. However, I think that as the virus progresses, people will take it very seriously, which implies that the reproduction constant probably won't be high enough for 70 - 80% of the population to be infected. I doubt that countries like the United States will be able to replicate the success at containment found in China, though I'm open to changing my mind here.
• I expect the infection fatality rate (a nonstandard term that means dividing the estimated number of people infected by the number of deaths caused by the virus) to be around 0.7 to 1 percent, with significant uncertainty in both directions. (That said, a paper that was released in the Lancet yesterday says the true figure is probably closer to 5.6% and could be as high as 20%. The sheer insanity of such a prediction should give you an idea of how uncertain this whole thing still is.)
• I expect the virus to temporarily peak in late April or May, but probably return in the winter and do a lot more relative damage given the cold weather.
• I expect hospitals in every major country to be overwhelmed at some point. This will cause the number of deaths to rise, making the 1 percent an underestimate of the true risk. My current (wildly speculative) guess is the true number is 2 percent in untreated populations.
• I expect that a vaccine will not be widespread by 1/1/2021, though I do expect one by 10/1/2021.
• I expect that some sort of anti-viral will be available by this winter, somewhat dampening the impact of the virus when it hits full force. Though it has yet to be seen whether anti-virals will be effective.
• I expect pretty much every country to implement measures like Italy is right now at some point, with the exception of countries with poor infrastructure that cannot manage such a quarantine.

I welcome people to view the estimates from Metaculus, which are more optimistic on some of these parameters than I am. So obviously, take the following analyses with a grain of salt.

Note: throughout this article I use the terms infection fatality rate, case fatality rate, and mortality rate somewhat interchangeably, and at times I do not know whether the author means something different by them. Some people often make careful distinctions between these terms, but it appears most people don't. Therefore, it's really difficult to understand what these analyses are actually saying at times.

JP Morgan

In the last 24 hours, JP Morgan announced that

The US economy could shrink by 2% in the first quarter and 3% in the second, JPMorgan projected, while the eurozone economy could contract by 1.8% and 3.3% in the same periods.

Their prediction is based on their research concerning the coronavirus, compiled here. In many ways, their estimates are quite similar to mine, and they share my sense that this virus will be long-lasting and painful. But in other ways they seem too optimistic. Here are some points,

• At one point they criticize the UK Government's apparent estimate of 100,000 predicted deaths, by saying "To arrive at such an outcome, we had to assume that 38% of the entire UK population is infected (i.e., similar to the 1918 Spanish flu), and that 40% of infected people get sick and then experience 1% mortality; or we had to assume that only 10% of infected people get sick but then experience 4.4% mortality that’s equal to the epicenter of the virus outbreak in Wuhan. Even after accounting for Chinese infection/death underreporting and the difficulty Western countries might have replicating what China has done (the largest lockdown/ quarantine in the history of the world, accomplished via AI, big data and different privacy rules8 ), both of our modeled UK outcomes would be magnitudes worse than what’s occurring in China and South Korea."
• They concur with my vaccine and anti-viral timelines, "While the fastest timeline for vaccines to reach patients is generally 12-18 months, (i.e., Massachusettsbased Moderna’s mRNA vaccine), COVID-19 treatments could possibly become available later this year"
• They cite the fall of H1N1's mortality rate estimate (seemingly) as reason to think that this coronavirus will follow the same pattern, "Early estimates in the fall of 2009 from the WHO3 pegged the H1N1 mortality rate at 1.0%-1.3%, since they were dividing (d) by (c). Four years later, a study from the WHO and the Imperial College of London4 estimated H1N1 mortality as a function of total infections, including both the asymptomatic and the sick. Their revised H1N1 mortality rate using (b) as a denominator: just 0.02%."

My opinion

Whoever wrote this report has done a ton of research, and makes some very intelligent points. It think it would be unfair to say that intelligent investors from JP Morgan "don't understand exponential growth."

That said, I differ significantly in my estimate of whether the UK Government's estimate is valid, and whether the mortality rate will fall just as H1N1 did. The author seemed to be saying that the mortality rate can safely be only be calculated as a fraction of those who got sick with severe symptoms, rather than the total infected population. This fact makes me think that they are underestimating the infection fatality rate.

Moody's Analytics

On March 4th Moody's Analytics released a forecast of economic growth conditioned on the coronavirus becoming a pandemic, which at the time they considered to have only a 35% chance of occurring. Even though this report is somewhat old now, I still include it because this was their 'worst case' report. Their conclusion was that,

Under the pandemic scenario, the global economy suffers a recession during the first three quarters of 2020. Real GDP decreases by almost 2 percentage points peak to trough and declines for 2020 [...] The U.S. economy contracts in all four quarters of 2020 in the pandemic scenario, with real GDP falling by approximately 1.5 percentage points peak to trough and the unemployment rate rising by 175 basis points. The struggling manufacturing, transportation, agriculture and energy industries are hit hard, but so too are the travel and tourism industries and the construction trades. However, there are significant layoffs across nearly all industries, with healthcare and government being the notable exceptions.

The modeling assumption was that "millions" would be infected, and that it would peak by March or April.

Under our alternative Global Pandemic scenario, we expect that there are ultimately millions of infections across the globe, including in Europe and the U.S. COVID-19’s mortality rate is assumed to be 2%-3%, consistent with the experience so far, and a similar percentage of those infected become so sick they need some form of hospitalization. The peak of the pandemic is assumed to occur in March and April, winding down quickly by this summer, with a vaccine in place before next winter.

My opinion

While I find their estimate of the mortality rate to be rather high, this consideration is swamped by the fact that they only think it will infect "millions" of people (which I take to be perhaps 5 - 10 million) worldwide, and the fact that they think we will have a vaccine by next winter. I think Moody's Analytics are seriously low-balling this virus.

This report is probably the best evidence that investors still aren't taking the virus seriously. However, given that this report is about 9 days old though, I think that conclusions from this report should be interpreted with caution.

Capital Economics

A report from Capital Economics came out in the last few days, however, I've been unable to find the exact report. Instead, I can quote media article such as this one, and this one. They report,

Capital Economics also cut its estimate for gross domestic product in 2020, saying the economy would expand just 0.6% instead of 1.8% as previously forecast. [...] Many economists have downgraded their growth forecasts for the second quarter and beyond, but the Capital Economics call is the most pessimistic one yet.

So apparently they expect positive growth for the year, and yet this is one of the most pessimistic predictions from economists? That is striking on its own.

Capital Economics predicts a rebound in 2021 on the assumption that strict social distancing works to contain the coronavirus epidemic.

“If such measures helped to stem the spread of the virus ... they may reduce the risk of a worse-case scenario, in which one-third of the population become infected resulting in a prolonged recession,” Hunter said.

[...]

"We think this is going to have a very significant impact on activity over the next few months," said Andrew Hunter senior U.S. economist at Capital Economics.

[..]

However, Hunter expressed hope that if the number of coronavirus cases in the U.S. peaked in the tens of thousands, then the U.S. economy could "start to recover reasonably quickly."

It's not clear whether their "tens of thousands" in the US is a best case or median case scenario.

My opinion

It's hard to get a real sense of what Capital Economics expects, but the article itself gives the impression that we can still contain the effects, and things will wrap up in a few months. But given that they also mention that billions of people could be infected, it's hard to tell whether they are over or underestimating. I don't have a strong opinion here.

United Kingdom report

On March 11, the United Kingdom released a (long) report on their economic forecast, taking into account the expected impact from the coronavirus. Unfortunately their report did not include the latest figures from the coronavirus, and therefore it's hard to tell whether they are underestimating things.

As set out below, we agreed to close the pre-measures forecasts for the economy and public finances on 18 and 25 February respectively, to provide a stable base against which to assess the impact of the large Budget package. This was before the spread of the coronavirus was expected to have a significant effect on economic activity outside China. As discussed in the document, the outlook is therefore likely to be significantly less favourable than this central forecast suggests – especially in the short term – but to a degree that remains highly uncertain even now.

RaboResearch

A firm called RaboResearch released a forecast on March 12th. They are relatively optimistic,

The coronavirus outbreak has led us to reduce our growth projection for the global economy to 1.6% y/y in 2020

However, their assumptions appear to diverge substantially from mine

Whether we will see a similar spread in other Eurozone member states as we have seen in Italy still remains in doubt – and for now we are not yet assuming that as a base scenario.

In their "ugly" scenario, which they consider unlikely,

would see the virus continue to rage in China, spread to ASEAN, Australia and New Zealand, and the cluster of cases in the US and Europe snowball at an exponential growth rate from their currently low base. In other words, developed economies would also be hit.

Unfortunately, they don't include any actual numbers, so it's hard to tell how bad their ugly scenario actually is. Their absolute worst case scenario, which they call "the unthinkable" also contains no facts or figures,

This scenario is very short. The virus spreads globally and also mutates, with its transmissibility increasing and its lethality increasing too. The numbers infected would skyrocket, as would casualties. We could be looking at a global pandemic, and at scenarios more akin to dystopian Hollywood films than the realms of economic analysis. Let’s all pray it does not come to pass and just remains a very fat tail risk.

Note that I did not bold global pandemic. That was their emphasis.

My opinion

Given that their "unthinkable" scenario describes a global pandemic, which the WHO has already declared, I find it hard to believe that this firm has a clear idea of the economic effects of the coronavirus. Their vagueness makes me think that they are not using solid models of the virus, but instead unsubstantiated intuition, and that they are probably underestimating the impact.

Media reports

According to this investopedia article, the top three stock market news websites are MarketWatch, Bloomberg, and Reuters. Due to the paywall on Bloomberg I only accessed MarketWatch and Reuters. Therefore, I have taken the time to open each of these websites, read the first article that I can see that seems to include both an economic forecast and some type of prediction about a parameter of the coronavirus. To be honest, I wasn't able to find anything really specific. Nonetheless, here are some quotes I found,

The vast majority of economists predict the U.S. will start to rebound later in the year, though they are split over how soon and how fast. Some like Donabedian see a rapid recovery starting in the summer. Others predict a short recession that extends through the fall.

The more optimistic view is based on the assumption that the U.S. approach to containing the coronavirus more closely mirrors that of South Korea or Hong Kong than Italy or Iran.

[...]

“We think we will see a nice bounce back in the third quarter,” Guatieri said.

Still, even relative optimists such as Guatieri say there’s still too much uncertainty to feel confident. He and Wells Fargo’s Bullard say their firms have been changing their forecasts almost daily in the past week as the situation deteriorated. What’s made matters worse is simply not knowing the scope of the problem

“We’re not getting the insight into where we are or where we are going,” Bullard said. “So we’re all just speculating.”

My opinion

Like many of the forecasts above, the articles are very vague about what they expect, and it's hard to see what values are being plugged into these economic models, or whether their prediction is intuition alone.

Conclusion

I have not seen strong evidence that economic forecasters are now predicting doom. However, I have seen some weak evidence that suggests that many are misinformed about the scope of the virus, and its potential future impacts. Some forecasters, like JP Morgan, have clearly done a lot of research. Other firms are barely even using mathematical models of the virus. My own interpretation is that the places I surveyed are probably fairly overoptimistic, though it's really hard to tell without more evidence and concrete numbers.

This blog post argues that the now popular idea of "flattening the curve", in the sense that most people get exposed but slowly enough to not overwhelm the health care system, is not feasible. The result is that we'll either achieve containment or at least widespread regional health care system collapse (and maybe Wei Dai's global health care collapse outcome [LW(p) · GW(p)]). I haven't spent much time modeling this yet, but tentatively it looks like flattening the curve requires very precise fine-tuning of R0 to stay on a path very close to 1 for at least several months, which seems impossible to pull off.

It feels to me now that flattening the curve is just a nice graphic without anyone checking the math, but I am confused that many informed-seeming experts are promoting the idea. Anything I'm missing?

ETA: I made an epidemic + hospitalization model (Google Sheets), it sure looks like the usual flatten-the-curve chart is a comforting fiction. Peak hospital bed demand in the uncontrolled epidemic scenario is usually drawn at 2-3x hospital capacity. I'm getting 25x and the chart looks a lot less reassuring. My shakiest assumptions are hospitalization / intensive care rates, any feedback there would be very helpful.

I think it would be valuable to compile a list of estimates of basic epidemiological parameters of the coronavirus, such as incubation rate, doubling times, probability of symptomatic infections, delay from disease onset to death, probability of death among symptomatics, and so on. I find that my inability to model various scenarios accurately is often due to uncertainty about one or more of these parameters (uncertainty relative to what I suspect current expert knowledge to be, which is of course also uncertain to a considerable degree).

Paper on some of nCOV's mutations

Incidentally, also strong evidence against it being a lab-strain. It's a wild strain.

Closest related viruses: bats and Malayan pangolins

Mutation Descriptions

Polybasic Cleavage Sites (PCS): They seem to have something to do with increased rates of cell-cell fusion (increased rate of virus-induced XL multi-nucleated cells). Mutations generating PCS have been seen in Influenza strains to increase their pathogenicity, and they had similar effects in a few other viruses. So it's not exactly increasing virus-cell fusion, it's actually... increasing the rate at which infected cells glom into nearby cells. Fused cells are called syncytia.

O-linked glycans : Are theorized (with uncertainty) to help the virions masquerade as mucin, so hiding from the immune system. (Mutation unlikely to evolve in a lab on a petri dish)

Arguments strongly in favor of it being a wild strain

• It's not that similar to one of the known lab-strains, so it probably was wild
• The "polybasic cleavage site" and "O-linked glycans" mutations would have required a very human-like ACE-protein binding site, so basically only human or ferret cells
• O-linked glycans are usually evolved as an immune defense, which isn't something cell cultures do.

(Just following the recommendation to move this out of shortform so it can be tagged later.)

Two facts:

1. HCoV-OC43 (one of human coronaviruses causing common cold) can generate cross-reactive antibodies against SARS.
2. Immunity to HCoV-OC43 appears to wane appreciably within one year.

Here's the paper which mentions both of these facts. (The actual paper is not important, I expect these facts to be well-known to coronavirus researchers, if the paper itself is not terribly mistaken and if I haven't misread anything.)

Even if cross-immunity is mild, won't it make sense to intentionally infect people with HCoV-OC43? Downside seems quite small compared to the number of deaths, and intuitively it seems that "mild cross-immunity" = "less severe SARS-CoV-2 cases", which is extremely valuable.

I notice I'm confused, since these facts should be well-known to pretty much everyone who's working on the vaccine. What's the explanation for why it's not a good idea?

Possible explanations, but I'm probably missing something:

1. Vaccines which cause the actual illness are considered unethical. (Probably not? I don't expect humanity to be that stupid.)
2. Mass-producing HCoV-OC43 virus is too hard for some reason. (Possible? I don't know much about vaccine production, and I'm clueless about whether it's even possible to mass-produce and store a "live" virus; but this seems solvable through organized infection parties, etc.)
3. Researchers or medical organizations don't want to rely on expected utility. Related hypothesis: time and productivity wasted by infecting many people with HCoV-OC43 is too valuable, and infecting everyone with HCoV-OC43 at the same time would hurt economy too much. (I don't believe this, but I haven't really tried to estimate this. If the alternative would be "wait for the real vaccine which is just around the corner", then yes, let's wait, but if the alternative is waiting for 12-18 months, then it doesn't feel right.)
4. Maybe I don't understand what "mild immunity" means and it's not that valuable of a perk to intentionally cause it? (But the same paper I quoted talks about HCoV-OC43 importance for predicting future SARS-CoV-2 outbreaks.)
5. Maybe being infected with HCoV-OC43 is too risky because getting two viruses at the same time is dangerous? Or because it would confuse the situation and complicate diagnoses of the real SARS-CoV-2? (Maybe... If everyone is sick with common cold then it would help SARS-CoV-2 to spread since everyone would be sneezing and coughing. But it also seems like a question of good timing and at least worth considering.)

So, what am I missing here?

This paper is well worth a read, according to me. Given that we have all kinds of problems doing testing for COVID-19 in the US, the authors do an analysis of the ratio of people seeking medical help for flu-like symptoms, but testing negative for the flu, to people testing positive (compared to previous flu seasons). The idea being that if COVID-19 is spreading, we should be seeing increases in flu symptoms relative to flu diagnoses.

However, I'm confused about Arizona. (See figure 4 in the paper). It looks like its score on this axis has been 2 to 3 standard deviations from the mean for the decade since November.

What's going on?

Hypotheses:

• The Flu season in Arizona was so bad this year that the number of people who came in with flu symptoms skyrocketed, relative to other kinds of ailments, and even though most of those people did test positive for the flu, the wILI term swamped the (1 − proportion of tests positive for influenza), for an overall much higher than usual ILI-.
• Is that mathematically plausible?
• There was some other flu-like non-flu that was spreading in Arizona since November.
• The flu diagnosis process spontaneously failed this season, producing orders of magnitude more false negatives, in Arizona, but not in any other state.
• COVID-19 has been spreading in Arizona since November, but somehow there are only 9 serious cases.
• COVID-19 has been spreading in Arizona since November, but testing is so ineffective, that there are hundreds of people with severe phenomena-like symptoms, who have not been recognized as COVID-19 cases, somehow.

What's going on here?

Why are we prioritizing testing the sickest people? AFAIK diagnosis doesn't change what care is given, so it's irrelevant to them. Testing people who might be sick and take high impact action based on the results (e.g. medic deciding whether to go to work) seems higher impact.

Possible explanations: sickest people get the most positives and that's important for contact tracing, I am wrong about how it affects care (in particular it might affect if you get an isolation room or no)

Several counties in California are now advising people not to bother self-quarantining at home after COVID-19 exposure unless they get symptoms. This seems wildly irresponsible to me. I understand not wanting to use valuable health system resources on people who are unlikely to have the virus, but home self-quarantine does not cost the health system anything now, and it is likely to save the health system a lot of cases later. Right?

https://www.sacbee.com/news/local/health-and-medicine/article241047391.html

This seems in particular very much at odds with Italy's striking decision to lock down the entire country, including whole regions with no known exposures.

Any thoughts?

What are the issues involved in receiving delivery food during this pandemic?

Can one safely receive and eat delivery food as follows: Avoid contact with the deliveryperson (have them leave it outside), carefully dispose of the packaging in the same way you would for a package delivery, then take the delivered food and reheat it in the oven for a time/cooking temp that will kill the virus?

The respiratory viruses as a family do not appear very resistant to heat (as compared to e.g. some of the foodborne illnesses.) From https://www.quora.com/At-what-temperature-does-the-cold-virus-die/answer/Thomas-Basterfield (I didn't check the citations yet), it seems like 70C for 25 minutes will kill most respiratory viruses thoroughly. This is such a low temperature that I wonder if hot food is inherently inhospitable to them even without the reheating step. My oven dial doesn't even go that low. (Getting the center of the food to this temperature could be challenging without using a higher oven temperature, but you really only need to do the surface; the center has already been cooked, and any relevant contamination will be on the surface from post-cooking handling.)

(There is also a mention of autoclaves, which apparently require <300F and <20 minutes at 15 PSI over atmospheric to sterilize surgical instruments. (Eyeballed numbers, do not trust.) In fact, I was able to find a published paper which concludes that a pressure cooker can be used in place of an autoclave with good results, https://www.ncbi.nlm.nih.gov/pubmed/12267939. So a pressure cooker (e.g. an instant pot) seems like another route to ensure delivery food is heated to a temperature that will kill viruses, although it's probably overkill and is likely to damage the texture of some foods, but is maybe a better option for foods that would dry out objectionably in the oven.)

(It also seems very likely to me that a microwave could achieve sufficient conditions for this, although I think it would be harder to be confident about it without at least having a meat thermometer.)

Does this seem like a reasonable approach?

[One thing I still have to figure out: I have been receiving "ready-to-heat" meals from https://www.freshly.com/. They are precooked but refrigerated, and require reheating. I'm not sure what my risk here is, and how much I can reduce it by just heating them longer in the microwave than the instructions call for.]

An review of Ferguson et al's paper by Nassim Taleb has come out: https://necsi.edu/review-of-ferguson-et-al-impact-of-non-pharmaceutical-interventions

I think this document contains the essential strategy for quickly bringing covid-19 under control. I'll call it "Containment and Eradication":

1. Close national borders

2. Reduce R0 below 1 using a thorough lock-down, social distancing, testing, contact tracing and hygiene

3. Once the outbreak is quite small and testing capacity is decent, aim to drive the number of infected individuals as close to 0 as possible

4. Test aggressively and wait a couple of weeks

5. Gradually return people to mostly-normal life, but with large gatherings cancelled for the foreseeable future due to the possibility of super-spreader events, and international travel mostly cancelled.

6. Keep borders fully closed to until we have a vaccine, or at least impose long quarantine periods on travelers.

Approaches to covid-19 that involve getting a large number of people infected to build herd immunity and minimize the damage along the way are far inferior to this. The Ferguson et al analysis showed us just how messy that would get, but I think it was probably an underestimate of the expected disutility of these "mitigation" approaches, as its estimates of the infection fertility rates didn't take into account the effect of health systems being overwhelmed. Furthermore, attempts to "flatten the curve" impose both economic and human costs for an extended period.

This is the most encouraging thing I have read about covid-19 in a long time. I believe that "Containment and Eradication" is the way forward and that this should be signal boosted.

As part of the LessWrong Coronavirus Link Database, I am publishing a daily update post with all the new links we are adding each day that we ranked a 3 or above in our importance rankings. Here are all the links we added over the weekend.

Guides/FAQs/Intros

Coronavirus: Why you must act now (medium post)

Summary and call to action, one of the best summaries I've found, focuses more on policy-interventions than on individual actions, but is still good at giving you an overview

UpToDate: Coronavirus Overview

UpToDate very frequently has the best overviews over many crucial medical topics. Geared towards a more professional medical audience. 

Letter to loved ones asking to take CV seriously

Well written, compassionate explanation of why this is worse than what we've seen before and need to take this seriously. A few pointers on where to get started

Early February 80,000 hours episode on Coronavirus (1h 18min)

Long episode on coronavirus. Includes all the basic information, and discussion of big-picture implications

Spread & Prevention

Masks help prevent infection in schoolchildren: 

In a group of 10,524 Japanese schoolchildren, masks and vaccination decreased the chance of catching influenza, gargling and handwashing increased the chance

Metareview: facemasks at mass gatherings 

A collection of 25 studies with 12710 participants was examined. Out of 13 studies on respiratory illness, 4 showed statistically significant effectiveness, 1 showed statistically significant ineffectiveness, the rest produced no statistically significant results

“Flattening the Curve” is a deadly delusion

At current medical capacity, we'd need to flatten the curve for 10 years in order to get everyone full treatment

Summary of papers arguing that many/most infections spread from people before they show symptoms [LW · GW]

A readable summary of some papers about how quickly people transmit the disease and how quickly the symptoms show. Argues that perhaps the majority of people transmit it before they show symptoms.

Timothy Gowers: Herd immunity is very costly, and we can't get all the things we ant

Twitter thread on costs of UK's herd immunity strategy, argues that we have to give up at least one of: (1) herd immunity (2) non-overwhelmed hospitals (3) get life back to normal before next winter

Paper: derives CV prevalence estimates from data on unexplained flu-like symptoms

The relative prevalence of patients influenza like illnesses that test negative for influenza has been high for the past several weeks, but not extraordinarily so (< 3 standard deviations)

Rob Wiblin: Model update suggests we are dealing with unmitigated exponential growth

Rob Wiblin updated his spreadsheet model with new data, which suggests that we are basically dealing with unmitigated exponential growth, without any significant slowdown

Progression/Outcome

Twitter: CV kills via cardiac failure, not pulmonary

Aapparently the ARDS is not too severe, and they can manage people through that part of it. Instead, after several days, the virus suddenly attacks the heart, causing it to precipitously fail. The myocarditis phase is savage and kills people within a day or two

Estimate of C19 death rate

Tries to produce more accurate death-rate estimates for China, South Korea, and Italy, based on interpretation of existing data

Seattle ICU Dr describes CV progression

The Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark,  elderly patients going to "comfort care", detailed description of clinical presentation, remdesivir is scarce

Doctor reports 20-30% reduction in lung capacity in 1/4 of patients

News report on a doctor saying that 2 or 3 out of 12 patients have seen a 20-30% reduction in lung-capacity and "They gasp if they walk a bit more quickly"

Medical System

Twitter: Seattle approaching Lombardy levels

Seattle has ventilators but is out of ICU beds. Due to a lack of machines, Seattle is restricting ECMO machines to people <40 yo and < 25 BMI. Most people are dying of heart, not lung, issues

Twitter: Seattle ICU Dr describes conditions in Seattle hospital

Entire ICU taken up by CV patients, CDC is weakening quarantine on medics, they are out of masks in part because people are stealing from them

Jess Riedel's Fermi Estimate that not containing coronavirus will overwhelm UK medical system

Jess Riedel's Fermi Estimate that not containing the coronavirus will overwhelm the UK medical system

Dashboards

Coronavirus case dashboard

Very comprehensive dashboard with dozens of graphs. Currently the best resource I know for tracking both national and global spread.

Aggregators

Medium.com Coronavirus page

Surprisingly high-quality of articles on the Medium coronavirus page. 

Aggregators

Effective Altruism Facebook group on Coronavirus discussion

Facebook group with lots of members of the EA community discussing various considerations and plans

Other

[TEMPLATE] Coronavirus Household Isolation Coordination v1.2

Spreadsheet for keeping people in your social network up-to-date with each other's health and social distancing status

Why now is a time of great opportunity for helping the world [LW · GW]

Detailing what opportunities are available (contact tracing, building entilators, remote work tech, etc) and framing why to take action and how.

Link to Full Database

How useful is it to heat your house to 75F+? To heavily humidify your house?

I’ve been keeping notes on corona virus risk reduction tactics and turned some of them into a webpage to share with my family and friends. The idea to to make them as quickly actionable/understandable as possible. This is the pretty version, but you can contribute here.

I'm very interested in critical feedback, including if any of these tactics are likely to be harmful/ineffective or if I'm missing anything high-value/low-cost.

A new paper: Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study says that vaccination for tuberculosis has a potentially large effect on COVID-19 problems. This explains some of the strange differences between countries. That's bad news for the U.S. (which hasn't required the vaccine), good news for some countries.

I'm still trying to understand how COVID-19 actually spreads. (Related to my recent question on touching-vs-breathing [LW · GW].) Based largely on this article, my current very-low-confidence belief (in decreasing order of importance):

• Top transmission risk: Being near (2 meters) someone coughing ... or talking! Talking emits droplets / aerosols too. Is that the key to the pre-symptomatic transmission we know is happening [LW · GW]? Hmm.
• Second transmission risk: Air in or around public restrooms. Apparently a SARS carrier with diarrhea was a super-spreader, infecting people 200 meters away!! That same link also discusses evidence that COVID-19 virus is found around bathrooms.
• Last transmission risk: Touching contaminated surfaces then my face. While I am ranking this at the bottom, it could still be important, and I continue to take the same gung-ho precautions as when I formerly thought this was the primary thing to be thinking about [LW(p) · GW(p)].

Again, very low confidence in all this. Thoughts?

We are looking for forecasters/"estimators" to help with estimating various COVID-19 parameters, such as number of infected cases, which will go into epidemic modelling, augmenting unreliable reported data. Ideally the end product should be the results of the modelling presented in a good web UI. If you would be interested in helping, reply privately.

Q&A: How does it compare to Metaculus? In a few important ways.

1. the estimates are not the end product, but an input to epidemic modelling software

2. in our UX, we want to clearly communicate the results of the epidemic are not pre-determined, but depend on actions humanity will take

3. we want to expose more of the uncertainties and underlying dynamic, as opposed to static forecasts

Read the Imperial College COVID-19 Response Team report tonight. https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf

The numbers are quite starkly grim, based on an epidemiological simulation model. They conclude that mitigation strategies (only isolating symptomatic people, social distancing only at-risk people) will at best reduce the load on the healthcare system to "only" 8x current surge capacity in UK/US, leading to estimated 1.1M deaths from COVID-19 alone (i.e., not considering possible deaths from other causes due to an overloaded healthcare system). Instead, suppression strategies (everyone socially isolating) need to be followed for 12-18 months to ensure that the load from COVID-19 stays within surge capacity, minimizing total deaths to the low hundreds of thousands, and buying time for a vaccine / treatment to help beat back a second epidemic after relaxing suppression measures.

I am curious about a few assumptions in their model (wish it was open-sourced!), and how this might change the estimate.

1) They assume a fixed ICU capacity (where I think the main limit is ventilators, not just beds). Does anyone have any models/estimates of how much UK/US can expand intensive care capacity (e.g., with "wartime" style all hands on deck manufacturing and innovation)?

2) I don't see any modeling of social network effects in the mitigation scenarios. I'm thinking of the conjecture in this preprint (https://osf.io/fd4rh/?view_only=c2f00dfe3677493faa421fc2ea38e295) that intergenerational interactions, co-residence, and commuting patterns in Italy might have unique effects on the transmission and mortality rates.

Has anyone seen discussion of these points from experts? Or done some modeling themselves that could speak to these issues?

Also curious what others think of the report.

I'm a nurse in an at risk area. Should I shave my long hair like the Chinese nurses were doing?

I know that a roommate of a friend if coughing regularly according to my friend. I'm living in Berlin. How likely is it that the roommate is having COVID-19 based on the available information? How careful should I be interacting with that friend?

Epidemiologist Behind Highly-Cited Coronavirus Model Admits He Was Wrong, Drastically Revises Model (archive)

Epidemiologist Neil Ferguson, who created the highly-cited Imperial College London coronavirus model, which has been cited by organizations like The New York Times and has been instrumental in governmental policy decision-making, offered a massive revision to his model on Wednesday.

Ferguson’s model projected 2.2 million dead people in the United States and 500,000 in the U.K. from COVID-19 if no action were taken to slow the virus and blunt its curve.

However, after just one day of ordered lockdowns in the U.K., Ferguson has changed his tune, revealing that far more people likely have the virus than his team figured. Now, the epidemiologist predicts, hospitals will be just fine taking on COVID-19 patients and estimates 20,000 or far fewer people will die from the virus itself or from its agitation of other ailments.

Ferguson thus dropped his prediction from 500,000 dead to 20,000.

Author and former New York Times reporter Alex Berenson broke down the bombshell report via Twitter on Thursday morning (view Twitter thread below).

“This is a remarkable turn from Neil Ferguson, who led the [Imperial College] authors who warned of 500,000 UK deaths — and who has now himself tested positive for #COVID,” started Berenson.

“He now says both that the U.K. should have enough ICU beds and that the coronavirus will probably kill under 20,000 people in the U.K. — more than 1/2 of whom would have died by the end of the year in any case [because] they were so old and sick,” he wrote.

Thoughts on this?

I have a lot of hand sanitizer I bought for a dance weekend that is now cancelled. What should I do with it?

EDIT: I gave some to an immunocompromised friend, some to friends who have critical jobs, and the rest to a food pantry

I was feeling rudderless trying to do actionable CV research without a grounding in its basic science, so I took a step back to build a foundation. These are the top sources that were useful to me:

• Medical Microbiology Chapter 57: Coronaviruses (less technical of the two, although still aimed at biologists)
• Coronaviruses: An Overview of Their Replication and Pathogenesis

These have also been added to the links DB

What's the best way to convince skeptics of the severity of COVID? I keep seeing people saying it's just a slightly worse flu, or that car accidents kill a lot more people, and so on. I want some short text or image that illustrates just how serious this is.

I found this heartbreaking testimony from an Italian ICU doctor: https://twitter.com/silviast9/status/1236933818654896129

But I guess skeptics will want a more authoritative source.

Should poly people consider stopping intimate contact (hugs+) at some point? The network structure of polyamorous relationships might make people particularly vulnerable.

[Epistemic Status: It's easy to be fooled by randomness in the coronavirus data but the data and narrative below make sense to me. Overall, I'm about 70% confident in the actual claim. ]

Iran's recent worldometer data serves case study demonstrating relationship between sufficient testing and case-fatality rate. After a 16 day long plateau (Mar 06-22) in daily new cases which may have seemed reassuring, we've seen five days (Mar 24-28) of roughly linear rise. We could anticipate this by noticing that in a similar time frame (Mar 07-19), we were seeing a linear rise in case fatality rate before it became constant. This indicates the following narrative (not sure if it's actually true):

• Coronavirus spreads uncontrolled in Iran without increased testing capabilities. This causes new daily cases to stay constant despite increased infection -- the 16 day long plateau in daily new cases
• Because cases are increasing, the number of severe cases is also increasing - - and severe cases are more likely to get tested than less severe cases. This causes fatality rate to rise as the severity of the cases that are actually tested increases -- the 12 day linear rise in case fatality
• Recently, testing capabilities were ramped, allowing testing of more people and the observation of less severe cases. As a result, the number of daily cases started increasing again with the testing rate. Simultaneously, the fatality rate plateau'd as the (complex) trend in severe cases being tested in greater proportion to less severe cases was cancelled out by trend in testing. Hence the last five days of daily new case rise and the past eight days of constant fatality rate.
• Note that this narrative suggests that testing is being continuously ramped up while remaining the bottle-neck. Two pieces of evidence for this:
• The daily cases start increasing linearly from the plateau. If testing was increased dramatically, one would an immediate discontinuous increase in number of daily cases at the point where more tests are done.
• Iran's death rate is still much higher (17% compared to an IFR which should be less than 5%) so testing is unlikely to be sufficient to capture the true infection rate

Metaculus has extended the Li Wenliang prize series - win $$$ as well as internet points by forecasting the course of the COVID-19 pandemic!

Today will always be the day that, for one hour, Facebook removed all posts/comments that had links to any of The Atlantic, Medium, and LessWrong. Because we're just that big and important.

(The issue is now fixed.)

Here's some perspective on U.S. stock market reactions to bad news (of nonfinancial origins):

• 1918 Spanish Flu: -10% in slightly over 5 weeks?
• 1940 Fall of France: -25% in slightly over 2 weeks
• 1942 Pearl Harbor: -11% in slightly over 3 weeks
• 2001 9/11: -12% in less than 2 weeks
• 2020 COVID-19: -26% in 3 weeks (so far?)

These numbers are based on closing values for the S&P500 (for 1918: the DJIA), from the day before the obvious start of the crash, to an obvious low point where it stabilized. Note that the reaction to the 1918 flu is confusing, maybe because WW1 ended just as the biggest wave of the flu ended. The big increase in death rates in New York started around October 1, and peaked in late October. Yet the DJIA was higher in late October than on October 1. I've calculated the decline from the October 18 peak to the November 25 low, but I don't think it took that long to finish reacting to the flu.

My intuition is that COVID-19 will cause no more harm than 9/11 or the 1918 flu. Why does the market act like this is slightly worse news than the Nazi occupation of France? It's not due to problems that are specific to the U.S. - many European markets are doing worse.

Yet the Shanghai Composite is down less than 8% from it's January high, and is above its early February low.

Maybe the U.S. and European markets had reflected a much safer world than anyone at the time of prior disasters had expected?

1/13 people have Asthma. How much worse off are we?

Here's a credible-seeming claim from a computational biologist that, if COVID-19 is like other coronaviruses, long term immunity is unlikely. I imagine this also means a vaccine is unlikely.

If true, this changes everything. Does this mean we are all going to be working from home for the rest of our lives? Or will we accept a world where there is an endemic disease that we get for 3 weeks every year?

A friend of mine (who lives in the SF Bay Area, currently somewhat of a coronavirus hotspot) posted to Facebook that he hasn't been feeling well recently and he thinks he might be sick (and was having trouble focusing at work yesterday). I posted the following; I don't know him well enough to know how he'll take it, but we'll see. I feel like we're still at a point on the curve where this kind of individual outreach can potentially have substantial value, so I'm offering it as perhaps a template for other people to use.

Yikes, good luck -- I hope you feel better!

If you can, please consider staying home from work and other events. Santa Clara County is a coronavirus hotspot right now, and we need everybody who is able to help reduce the spread. (That doesn't mean you have it, but you very much could.)

If it is the coronavirus: most cases (~80% average, but more than that in younger people, and people without major preexisting conditions) will resolve on their own without treatment; but if you do need medical attention, make sure you call ahead first. I believe self-quarantine is recommend until end of symptoms plus 24 hours, but there is evidence of viral spread until up to 10 days after start of symptoms, so I would suggest whichever is later. "Secondary attack rate" -- that is, the rate of spread to close contacts -- has been estimated at up to 10% for family/household members, so keep that in mind.

Please let me know if there's any more information I can provide or anything I can do to help.

Does anyone have updated figures on the fatality rate for different age groups, compared to the ones posted in this [LW(p) · GW(p)] comment?

I imagine that that table is mostly based on data from the early outbreak in China, which may or may not generalize well to say, my parents.

Questions about buying chloroquine:

1. Is it better to buy hydroxychloroquine or regular chloroquine? The studies I've found suggest hydroxychloroquine is safer and more potent, but it is a bit more expensive.

2. How many days worth of the drug is it reasonable to buy per person?

3. How much should someone take per day and how should the dosage be timed?

4. Can someone confirm that the products you can find on reliablerxpharmacy.com when searching for "Lariago" (500 mg chloroquine as phos) and "OXCQ" (200 mg Hydroxychloroquine Sulfate) are the right things to buy? If not, is there any other reputable or semi-reputable source that sells the right product?

Hi, I haven’t posted in a while, and I hope that people are still reading new comments in this thread, because I need an answer fast, and this is the best place that I know to get a good one. (Well, second best. I posted to SSC first.)

My parents, age 70, live in Lincoln NE (population 285 thousand, no reported cases of Covid-19 yet, 17 reported cases in the State, schools just closed and are preparing to go online). They pretty much run their bridge club, most of whose members are in their 70s but generally in good health. The club has an event planned for tonight (March 15 Sunday), at which 26 people are expected to show up and sit at card tables in close proximity, moving from table to table over the course of the evening. There will be hand sanitizer available at the tables.

Question: Should they cancel the event?

Please give reasons for your answer as if you’re trying to convince a stubborn Boomer (but not a Trump-supporter). You may assume that your audience is mathematically literate. If you know any data on age-related risks that controls for other risk factors, then that would be a big bonus. (Because since heart disease, diabetes, and lung disease are all risk factors for Covid-19, and since they’re also all more prevalent among older people, maybe age alone is not much of a risk factor all.)

I have created the top two graphs of my previous post [LW · GW] on outbreak speeds as interactive versions here (thanks to Ruby for helping with getting this uploaded). The labels on the right are clickable to remove or add countries (double click selects only that country or all countries). The buttons at the top change the y-axis (annoyingly the y-axis range buttons auto-set to a linear scale) and the slider at the bottom zooms the x-axis.

We started an effective altruist coronavirus discussion group on Facebook and there are a lot of posts in it. The link is here if you're interested.

From a friend who is a microbiologist Phd "Oh and drink plenty of water. My lab group discovered that humans and cows partially rid their body of viruses (at least adenovirus) through their urine. "

I recommend people write covid-19 things here rather than in shortform, because soon we'll have tagging properly implemented for posts, but not for shortform, and it'll be easier to find all coronavirus related commentary if it's here.

The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.

Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%.

John Ioannidis is making an interesting (and reassuring, if true) claim here. Has anyone looked at the demographics and done the comparison themselves?

Does this thread welcome asking for highly personalized advice? I'm stuck with a few possible action options and the explanation is quite lengthy and the answers will probably be relevant to very few. I can't decide whether this thread is only about posting globally useful things or not.

In the usa, much of the workforce is paycheck to paycheck and does not have paid leave or short term disability, and health issues are a common cause for bankruptcy. So the following is applicable to a lot of people who probably are not in this (rationalist/lesswrong) community:

If you don't work, you don't get paid, so you don't make rent. If you get quarantined by the state after a positive test, you don't go to work, you don't get paid, and you don't make rent. If you don't make rent, you probably will not have a place to live. If you end up in the hospital, you will probably go bankrupt, and may not have a place to live when you get out. Therefore with the incentives in front of you, take the following advice: 'do as you would normally, go to work no matter how you feel, do not under any circumstances get a coronavirus test, as that might provoke some authority to put you in a position where you cannot get paid.' This is particularly relevant if you live in a state that decides to be aggressive and punitive about quarantining.

Walmart appears to have realized this and is taking measures to adjust the incentives, but it's probably too little too late.

https://corporate.walmart.com/newsroom/2020/03/10/new-covid-19-policy-to-support-the-health-of-our-associates

I also expect red states to adopt punitive legislation and pundits representing those communities to not understand why it makes things worse (I've seen right wing blog comments that go something like this: hurr in the days of bubonic plague communities in Italy bricked up houses around infected families, we r not hard enough nowdays durrr).

For the rest of us, recognize that when you interact with a gig worker or any other member of the public with those incentives, they have a high risk of exposure from the community, are unlikely to use PPE (not part of the uniform, not affordable, etc), and regardless of whether they are showing symptoms, will probably work until either prohibited from doing so, or physically unable to due to symptoms.

I'd prefer to live in a community that took effective large scale action (lock down access to vulnerable groups, mass test the healthy, and create strong incentives to self-isolate), but I don't so whatever.

I have been taking NAC (n-acetylcysteine) as a supplement for a while.  You can (still) buy it on Amazon.  From an Elsevier press release "The authors draw attention to several randomized clinical studies in humans that have found that over the counter supplements such as n-acetylcysteine (NAC), which is used to treat acetaminophen poisoning and is also used as a mucus thinner to help reduce bronchitis exacerbations, and elderberry extracts, have evidence for shortening the duration of influenza by about two to four days and reducing the severity of the infection".  Anecdotally, I stopped taking NAC for a few months and happened to catch a cold.  The phlegm took longer to go away than normal and I happened to read that NAC, which I still had, helped with phlegm, so I started taking NAC again and my phlegm problem quickly went away, at a faster rate than it had been.

I'm particularly interested in people sharing models / spreadsheets that they're currently working through here. (Posting them as top level posts is also fine, but I thought it might be good to encourage more "thinking out loud" in quantitative ways, even while you're still fleshing a model out and still have a lot of open questions about it)

I'm still pondering the implications of transmission being mainly about air, not touching [LW · GW]. What interventions does that suggest? Besides the obvious things (opening windows [LW · GW], HVAC filters etc, masks & goggles), one thing I thought of is ... perfume!

We could all encourage everyone to wear perfume / cologne when they leave their home, and if anyone can smell anyone else, then they know you're not sufficiently well physically-distanced (too close or not enough air circulation).

Assuming this would work, I'm not sure how to get it to take off. Maybe an unusually considerate boss of an could tell their employees to all wear perfume (if they have any), to help ensure that everyone is keeping safe distance from each other, and to identify HVAC gaps? Or I could wear perfume and a hat / T-shirt that says "if you can smell my perfume, you're too close!" I dunno, just brainstorming :-P

Suppose one of the drugs under investigation for COVID-19 effectively reduces its morbidity and mortality. For simplicity let's say that it quickly and completely cures 90% (or X%) of patients but does nothing to the remaining 10%, and we manage to scale up manufacturing enough to be able to treat everyone with the drug. Would the major developed countries then decide to relax the current mitigation/suppression policies and let the pandemic run its course (thereby accepting the morbidity/mortality of the refractory 10%) in order to revive their economies? What do you think the threshold for X would be for the major developed countries to do this?

Someone on Hacker News had the idea of putting COVID patients on an airplane to increase air pressure (which is part of how ventilators work, due to Fick's law of diffusion).

Could this genuinely work?

The New York Times heavily implies that many sick package delivery workers are feeling pressured to show up to work despite their illness.

A sneak peak at the coming economic impact:

Google trends: How to file for unemployment.

https://trends.google.com/trends/explore?date=today 3-m&geo=US&q=how to file unemployment

Many have probably seen the threads (e.g., here and here, and this Medium post by Yishan Wong) about how massively scaled up testing is the key to threading the needle between economic collapse (long-term suppression tactics) and unacceptably high mortality (mitigation only, or worse, doing nothing). Aggressive and scaled up testing infrastructure is the key enabler for contact tracing, which appears to be the cornerstone of the South Korea model, which notably does not rely on draconian suppression tactics like lockdown, and they are currently the only other country than China (that I know of) that has R0 < 1.

I'm now wondering if, in the spirit of wartime efforts, more people can be trained to help power this testing infrastructure than can be trained to help increase our healthcare capacity.

Is somebody keeping track of the "what if we're wrong and it turns out this is another Y2K" scenario? Social distancing, closing borders, heightened awareness and preventative measures -- seems like a lot is happening that could make this way less scary, at least in the US, than most of the mainstream scenarios.

I'm not interested in the hearing from denier-types who think this is "just another flu", but rather the thoughtful people who have specific testable predictions that would demonstrate this is more social contagion than most of us suspect.

Ohio health official estimates 100,000 people in state have coronavirus:

https://thehill.com/policy/healthcare/487329-ohio-health-official-estimates-100000-people-in-state-have-coronavirus

This sounds crazy, but I don't understand the methodology so I'm not sure... Do people think it's plausible?

How should I disinfect objects with complex surfaces (e.g. box cutters, door knobs) if I don't have access to alcohol? Is brushing with soap likely to be sufficient or should one just avoid touching these objects for a few days if they're possibly contaminated?

How about an app that trains you not to touch your face?

Point your phone's camera or a webcam at yourself while you're working. The app produces a beep whenever you move your hand near your face.

Technically feasible, I'd say. Someone familiar with iOS/Android computer vision APIs should be able to put it together in a few days.

I wish I didn't have to see the deluge of coronaposts in my feed or under Latest Posts.

My wife's doctor said chloroquine (a treatment for malaria) was shown to be very promising in treating COVID-19. I guess it's public now as well: https://www.wired.com/story/an-old-malaria-drug-may-fight-covid-19-and-silicon-valleys-into-it/

Subway use in New York is only down 20%. And mask use is rare. How is NY not completely screwed?

How much should COVID-19 update me about the risks from pandemics?

I thought I'd share the steps my housemates and I have taken to be safe from the coronavirus, just to spread info about what people are doing. I'd be interested in others saying some things that they've done. This isn't exhaustive, I've almost certainly forgotten some things. (Note that we live in Berkeley, California, US.)

• We don't meet anyone from outside the house / go to work / go shopping, and generally stay in the house/garden. Some housemates take walks / go for a run, keeping 6 feet away from people at all times.
• If anyone thinks there's a need to leave for any reason, even if it's to help the house in some way, they get permission either during a house meeting or via the house Slack.
• We've put up proper hand-washing signs by all the sinks, and all do this regularly including around mealtimes.
• We have stored about 3 months of food and necessities per person. Every 2 weeks, we'll order 2 weeks of food+necessities on Amazon/Instacart, to have a clear headway in case any ordering services end up having month-long delays due to massive rise in demand.
• We have bought a cheap car for any important travel and also to take trips to places where there are no people (to go for walks and so on).
• We've covered basically all doorhandles, edges of drawers, and similar surfaces, with copper tape.
• We leave packages outside for 2 days before opening them, or else using gloves, throw the cardboard away, disinfect the contents with disinfectant wipes, then remove gloves.
• I'm taking a multi-vitamin each morning for the vitamin D.
• Oli and I have set up an office space on the top floor outside my bedroom, with desks and monitors and such.

A few other our-situation-specific things we've done.

• One person recently came back from international travel, so we got them a small solo AirBnb for 10 days and provided them with lots of food and snacks, to confirm that they're symptom free. (They were careful on the flight, using disinfectant wipes on the plastic on their seat, not accepting anything from cabin crew, etc.) They'll return to the house this week.
• We had a non-rationalist renter who was moving out in the next month or so. They were unfortunately still using public transport and going to work, so we paid for them to have an AirBnb for that duration, and they've now finally moved out.
• I got a VR headset for fun and exercise (BeatSaber is great!).

There's a bunch more things we've done for the community, though that overlaps with things the LW team has done (e.g. Ray set up a community-wide spreadsheet for people to report the steps they'd taken and what level of exposure they are at).

Write or message your local county public health department to include a history of the number of new cases per day not just the current total on their covid-19 website. Growth rate is just as important as the current state.

Anybody know the rough cost-benefit tradeoff of donating blood products a doubling or two from now? [EDIT: this place is not packed, but there are people there, and I'm obviously in contact with the nurses]

I'm currently in an apartment in Washington, DC living with one other family member. I have decided that I want to self-quarantine completely (i.e. no leaving the apartment, deliveries only), and the other person is saying that they are willing to mostly quarantine (i.e. work from home, no trips to the store, etc.) but they aren't willing to refuse to go outside.- they want some fresh air. Is there a good way of modeling the risk associated with just going outside and walking around? And of the family member then giving it to me? I do have another place to go all by myself but I would rather be with my family and I'm trying to get a sense of what the additional risk is.

I'm 32 years old and most concerned with the idea that I will get infected and the hospitals will be filled up so I won't be able to get a spot. I almost think that the safest place to be right now is somewhere like Hong Kong, South Korea, or Singapore, that's already contained their outbreak? Should I just get on a plane right now to one of those places? (I can easily afford the ticket)

Here's a method to try to estimate the number of cases in a region which I haven't seen calculations of:

1. Identify the places which have the best testing regimes

2. Try to estimate what fraction of cases are identified in those places, potentially along with other variables like how long from infection until the case is identified

3. Use those numbers to extrapolate to other places, based on other similarities between those places besides # of confirmed cases (e.g., number of deaths, or rate of infection in travelers coming from that place, or hospital utilization rate)

I have made some initially attempts to do this, which I'll try to post later today. I'm wondering if anyone has thoughts or sources on any of these 3 points (e.g., which places have the best testing regimes?), or on the method as a whole.

Here is a summary of an ebook about the economics of the Coronavirus:

http://conversableeconomist.blogspot.com/2020/03/some-coronavirus-economics.html

It also contains this figure:

https://1.bp.blogspot.com/-OZM_DUZq8eI/Xmj2kbpt57I/AAAAAAAAKQ4/Viik1kZDuZEalcQ2zP-yKYVgwcbh1kgZgCLcBGAsYHQ/s400/coronavirus%2B1.jpg

I have the impression that there are a lot of windows in public transportation that currently aren't opened due to it being cold outside.

It's likely beneficial to get to a state where all the windows in public transportation that can be opened are actually opened.

There might be a high value in pushing that meme as it's an easy intervention.

Is it anticipated that COVID-19 will have more estimated cases than the seasonal flu? Would appreciate a link to supporting info.

Is R0 the best way of measuring contagiousness?

Two related "wild" ideas, as I think we probably have the basic technology and knowledge but probably not something we can quite do now.

My understanding is that the virus is attacking the ACE2 molecules. These actually form a gateway between the interior of the cell and the external environment.

If so, in theory, we might be able to create a number of artificial "bodies" -- thinking just a lipid bilayer sack with some ACE2 elements attached. Any virus that binds with that will "infect" the dummy cell but have no way of replicating so effectively die and not infect the body.

Similarly, a mask, even one that is not quite as fine filtered as others, which is impregnated with such compounds might prove effective as a filter for this specific virus.

Anyone know of any virological sources that are might be digestible by non-experts that might discuss such approaches?

Are there statistics/tables listing not only infections, but also not-infections with circumstances (X was quarantined because of contact with Y, but turned out to be negative)? This might help to assess the risk associated with certain situations (quickly buying something in a store, conversation in open air with distance, in a closed room etc.)

This looks sketchy to say the least (e.g all citations are self citations), but seems worth doing a very shallow dive into or pointing out if clearly flawed: claim that yogurt can prevent secondary bacterial pneumonia in COVID-19 patients. The argument seems to at least imply that secondary bacterial pneumonia leading to cytokine storm is a common pathway to fatal cases.

(H/t Rob Wiblin on Twitter)

Is there any information on how exactly the testing process works? I'm trying to determine whether pool testing could be worthwhile. Test 10 samples at the same time to confirm if they're all negative. If not, test them all separately. At worst that's 11 tests to confirm postivie cases for 10 people, yet only one to clear 10. There's a million variables like expected infection saturation, grouping by symptoms/likelihood of infection, cost of the tests, duration of testing, number of test stations(is this even a bottle neck that needs a solution?) and of course there are better ways to group samples, but I'm no mathematician to think of a proper protocol/algorithm for that: group size of 100 with halving of the groups in case they test positive? To speed up the process the multiple samples needed for several stages of testing would be collected at the same time.

Interesting comment on a (maybe) new symptom, i.e., loss of smell and taste for several days, of a COVID-19 infection in an interview of a MD with focus on Virology in Germany:

Google translation of the interesting part:

"Almost all infected people we interviewed, and this applies to a good two thirds, described a loss of smell and taste lasting several days. It goes so far that a mother could not smell the full diaper of her child. Others could no longer smell their shampoo, and food began to taste bland. We cannot yet tell exactly when these symptoms will appear, but we believe a little later in the infection." (emphasize mine)

Sample size: approx. 100 patients, not very severe cases, i.e., no hospitalization (stated in the interview).

German newspaper source: https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavirus/virologe-hendrik-streeck-ueber-corona-neue-symptome-entdeckt-16681450.html

Google translate link to English: https://translate.google.com/translate?hl=en&sl=de&u=https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavirus/virologe-hendrik-streeck-ueber-corona-neue-symptome-entdeckt-16681450.html

However, I am not sure what the base rate of smell and taste loss is during an influenza or common cold infection?

I am suspicious of the general advice against non-frontline health workers using masks (i.e. that anything short of a properly-fitted N95 mask is not only useless, but possibly does more harm than good). This air filter company claims that not only are masks a lot better than nothing; even home-made masks bodged out of cotton t-shirts or pillowcases catch 50-60% of virus-sized particles. Or as Naval suggested on Twitter, "billions of Asians aren't wrong."

I don't know whether this is correct, but am leaning towards wearing a mask in public (I have a cloth cycling mask with insertable filters, so I'm not keeping them from medical professionals). Has anyone looked into this?

Are there attempts to build an app that tracks everyone by GPS, and notifies all possible contacts (and people having been in the same supermarket etc.) when someone develops a cough?

It seems to me that, with a majority of people using such an app, the R0 could easily be pushed below 1 without too many restrictions. I think this could even work when using the app is on a voluntary basis - I guess that people making wrong statements in such an app and getting someone sick amounts to negligent assault in many countries.

I don't believe the claims that 60% of people getting infected - or even a month-long quarantine for everyone - is unavoidable with such a technology, and would like to hear differing opinions/see data suggesting the opposite.

Does anyone want to venture a guess for the true number of cases in the Bay Area right now?

I just some rough back-of-the-envelope calculations, following the method here. Currently there are 2 deaths in the Bay Area. I keep his time-till-death rate of 17.3 days, but substitute a doubling time of 3 days, based on Our World in Data's US number. I get 2*100*exp(17.3*.231) ≈ 11,000, or about 2/1000 bay area residents. Super non-robust number, take with several grains of salt.

(.231 is the rate I get when solving for r in the exponential growth function for a doubling in 3 days.)

It had not occurred to me that there were any obvious companies a person could invest in to benefit from (and contribute to and accelerate) the response to the pandemic, but https://www.lesswrong.com/posts/yuyvosHTgjDR4giPZ/why-don-t-singularitarians-bet-on-the-creation-of-agi-by [LW · GW] mentions the videoconferencing software Zoom. It does seem to be the best videoconferencing software, from what I've heard. It's rare that I've ever had an international internet call from new zealand as stable as the ones I had on Zoom.

Any other industries a person could invest in? Food delivery, perhaps? In NZ I've been seeing lots of posters and qr codes in restaurants for a chinese service called Gogo, though if it's based in china we probably can't buy any of it.

Hi, I have another few questions I'm interested in to help understand my own risks from the virus:

• What's a good estimate for the percentage of the US population infected, right now?
• What is the likelihood of transmission inside the home (i.e. if one of my family members gets it, what's the chance that I will get it?) What things can we do in the household to reduce this probability?
• I'm concerned about the possibility that if I get it, there won't be hospital beds available. Would it make sense to, at the first sign of symptoms, get on a plane to somewhere like Hong Kong or Singapore (or maybe Canada if things are better there) where things are more under control? That way there will be beds available if I need them. (Or maybe even do that preemptively, now?) Is that idea just totally crazy? (Money is no object)

A strong preventative measure I haven't been hearing people talk about in general is constant cleaning of commonly touched surfaces. In workplaces and homes, this may be more valuable than encouraging people to wash their hands very often.

The Coronavirus can persist on steel, metal, wood, and plastic for up to 4 days according to the link below. Cleaning surfaces several times per day with an appropriate cleaning agent would therefore be highly valuable to implement.

There's not much point in constantly washing your hands if your office/home's front doorknob is spreading the virus to every person who touches it for 4 days in a row.

The SARS-CoVStrain P9 and HCOV listings in the link below are (I think) the best examples to look at. Best cleaning agents are those with 4+ "Reduction of viral infectivity (log10)" on the 2nd table.

https://www.journalofhospitalinfection.com/article/S0195-6701(20)30046-3/fulltext#sec3.1

Can we estimate what level of the disease will overtax US hospitals?

This page says that three are 924,107 "Total Staffed Beds in All U.S. Hospitals." Is that a good estimate of overall hospital capacity?

Does that mean that if/when ~ 1,000,000 people in the US have symptomatic cases, the hospital system will be at capacity?

It seems plausible to me that the copper tape approach many LWers have adopted is counter-productive in at least some cases. The logic for this is:

1. In the pictures I've seen, and with my own applications of copper tape, to the surfaces we seem to touch most often (e.g. doorknobs, light switches) applications of it have created a number of small creases, bumps, ridges, and/or folds.

2. Copper does not seem to have nearly as strong an effect on surfaces as does wiping them with disinfectant.

3. Wiping them with disinfectant seems likely to be a lot less effective on surfaces that aren't smooth (bumps, ridges, etc.) due to the difficulty in wiping all parts of the surface.

Thoughts?

My impression is that some Fermi estimate approaches assume that exponential growth indeed goes on until it hits the wall of 100%. Exponential growth is represented by ds/s = x, where s is the stock (here of infected people) and x is a constant. To my intuition, logistic growth ds/s = y (1-s) is almost as simple and it has the feature of a built-in limit. Of course both models imply 100% infection rates, but the second one asymptotically. The logistic model in this specification has highest absolute growth when 50% are infected, then lower (but still positive) growth because, e.g., infected people meet more who already infected.

Sorry if this is already common knowledge.

Should we be buying something like oxygen concentrator/medical ventilator futures? This might make money and increase production. I'm not sure how to go about it, though.

Assuming kids catch and spread the virus without sickening much, and that immunity among previously ill adults is robust, I would send my kids to a summer camp with immune counselors and lots of spit swapping (bobbing for apples, spin the bottle, being kids).

Any plausible way to use the mildness of illness in kids to develop herd immunity more quickly, rather than having them return home to parents and grandparents every day with deadly sniffles from the viral reservoir that is school?

Is it possible that there are different viruses we're dealing with here? It just doesn't make sense to me that we're seeing such varying death rates, eg. Italy vs South Korea. The difference in medical quality doesn't seem like it can explain it.

A random thought: If the virus doesn't survive well in high temperatures would going to a sauna help treat it?

Last month, NIAID RML released an album of SEM and TEM images of SARS-CoV-2. This includes the multi-coloured image everybody is using but also a lot of other very striking images. Check it out!

Consider getting a humidifier in case someone in your household gets COVID-19, because high humidity might reduce the transmission of the virus.

I remember reading some speculation that Zinc supplements and (separate speculation) garlic supplements might have some beneficial effect against COVID19, but can't find the source. Anyone knows what's the status on that?

I have seen quite a bit of advice here or elsewhere but not so much what people actually do. I'd like to post a poll but unfortunately that is no longer possible. But maybe you can comment here what you do.

In the spirit of this question I have written this on my FB page:

https://www.facebook.com/gunnar.zarncke/posts/1142992466050982

Is there anything precise known about the distribution over the severity of symptoms I should expect as a 20-30 year old? I'm in that age-group, that's why I'm interested.

So, what I'd like to know specifically, conditional on being infected, is:

• How likely would I be asymptomatic?
• How likely would I have symptoms not more severe than the common cold?
• How likely would symptoms comparable in severity to the flu (being mostly in the bed for maybe 2 weeks but nothing more)?
• How likely would I have mild to moderate pneumonia with which I could still stay at home?
• How likely would I need to go into the hospital and receive oxygen, but no mechanical ventilation?
• How likely would I need mechanical ventilation?
• How likely is it I might die even if I receive mechanical ventilation?

My roommate tested positive for type A flu. Does this mean he is unlikely to have COVID?

It's a mystery for me why https://www.lesswrong.com/posts/aqTwwvBv84rjqKvnk/why-isn-t-increasing-ventilation-of-public-spaces-part-of [LW · GW] hasn't received any votes. It seems to me a very crucial question which a lot of possible upside if we get it right and get the information out about a easy to implement beneficial intervention.

This seems like a good time to sign up you and your loved ones for cryonics

Here's a preprint published on March 10th testing how long coronavirus can last on a variety of surfaces.

This is an interesting timeline of people in different countries (or speaking different languages) looking for information on the corona virus - based on Wikipedia view stats:

https://towardsdatascience.com/coronavirus-interest-inwikipedia-by-language-1b3e6562040d

EDIT: The South Korean press releases contain a chart somewhat like the one I wanted, see e.g. https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030

I am looking for a better overview of imported cases by country of origin in East Asian countries.

EDIT: I remembered incorrectly, the following is wrong. In particular, I recall a statistic according to which a significant number of imported cases in South Korea in one day ~1-2 weeks ago came from China (~12, vs ~40 Europeans).

If this is true, this would seem to me like strong evidence that China is lying about having all domestic cases isolated, and community spread suppressed.

Does COVID-19 have a long "incubation period" because we don't have any immunity to it?

This is a "makes sense to me" idea I merely thought of, and I have 0 medical expertise. So this is probably dumb, but now that I've thought of it I keep wondering whether it's true.

My thinking is that the early symptom onset we feel when we get a cold or flu is partly down to our immune system responding, which causes inflammation etc. With the novel coronavirus, the immune system isn't responding early on, and the infection itself will be in the slow ramp stage of its exponential growth, so the infection is already well established by the time you start to feel it.

Does anyone have thoughts on the recent Oxford study that claims that only a very small minority of infections lead to hospitalization or death, and that >50% of the UK population is already infected?

https://www.dropbox.com/s/oxmu2rwsnhi9j9c/Draft-COVID-19-Model%20%2813%29.pdf

Covid-19 Genomics UK Consortium - A project to map how COVID-19 spreads and behaves by using whole genome sequencing.

Some info. from Cambridge and Glasgow Universities (UK government/NHS many other UK universities involved too).

I've just stumbled across this press report:

A man has died and his wife is under critical care after the couple, both in their 60s, ingested chloroquine phosphate, an additive commonly used at aquariums to clean fish tanks. Within thirty minutes of ingestion, the couple experienced immediate effects requiring admittance to a nearby Banner Health hospital. 

No mention of how much they ingested.

Chloroquine phosphate for fish-tanks, not human grade.

But a little knowledge without understanding can be a dangerous thing ...

A meta question - can we find areas with mismatched incentives (à la https://equilibriabook.com/ ), and biases, where the applying the rational thinking methodology would have high leverage? What can LessWrong do better than official science?

Favipiravir - I have not seen this yet here, but it looks actually even more promising than chloroquine: https://en.wikipedia.org/wiki/Favipiravir

Reduction from 11 to 4 median days of treatment.

Looks like the OurWorldinData has a graph showing a decrease in the total number of reported new cases for the world. Obviously, one observations is nearly meaningless but might be a sign that the curve is starting to flatten.

As a child who repeatedly got tonsillitis several times a year, sometimes when totally isolated and sometimes later hearing everyone else around me also got a sore throat, I grew up confused as to why contagious disease tracking was a problem we'd given up on and accepted. No doctor was ever curious of the specific virus or bacteria which caused it. While no one case greatly affected my life, as a whole they very much did. Then again, I was also struck by the possibly false realization that many STDs which have followed us for thousands of years could be permanently wiped out by a couple weeks of global abstinence.

Might we begin to have an intersection of low cost, widely-available tests for every strain of most every contagious agent along with a belief that contagions running amok in civilization is not an unchangeable reality after all this? These at-home DNA tests will soon hit a critical mass of data to link together a global family tree of every human--a previously unthinkable reality that'll suddenly become possible. I'm ready for such a critical mass in contagion tracking that makes a light bulb go off in our collective heads that contagion no longer be an essential part of civilization. Feel slightly sick or have been around someone coughing? We mailed you an envelope of 6 paper swabs for the back of your tongue that'll change color when exposed to the viruses we're aware are circulating in your area.

Learning that a specific RSV strain overwhelmed a daycare and infected 6 babies because my cough I got on a trip to a hotel upstate was cleaned by a chambermaid who got it from... would strongly alter my belief about the inevitability of even minor contagions in the same way the person to person tracking and quarantining of Coronavirus cases is radically altering our social and hygiene landscape right now. Even if widespread testing only shook the "people just get sick for a couple weeks once or twice a year; it happens" attitude of inevitability, it'd be worth it for that alone once it was economically feasible.

I'm gathering info on anti-COVID-19 drug efforts. Here is what I've compiled so far. I've combined the number of trials in various phases with big data on expected success rates for drugs in those phases to forecast an 80% probability that at least one drug currently in phase 1-3 testing will be approved. Because trial efforts are unusual, I've used the following categories in my model:

0: pre-trial (not factored into probability of success)

1: new drug in early testing

2: approved drug being tested against COVID-19

3: official phase 3 trial

This is just the product of a morning's research, so if anybody finds better information, I'd appreciate it if you'd link a source so I can include it.

Remdesivir is the drug we'll know about soonest - one expert is quoted as saying in a couple months, so around May 2020. Other analysts say they're optimistic that production can be scaled up quickly. It treats the pneumonia of severe cases, so it might cut down on mortality. Other treatments are also being tested.

The CDC projects that "In the coming months, most of the U.S. population will be exposed to this virus." If the virus grows exponentially, the relative timing of a Remdesivir rollout and a COVID-19 explosion could matter hugely in terms of mortality.

Remdesivir has been administered via compassionate use permission already for at least 15 patients who weren't part of the trial (which is recruiting volunteers now). So although we won't know its effectiveness for a while, if it is effective, it can potentially begin saving lives immediately via compassionate use permission.

Is this the right kind of copper tape for keeping surfaces virus-free? I'm concerned because it doesn't seem to have sharp edges, which I've heard is a big issue with the right kind of tape

https://smile.amazon.co.uk/Selected-Repellent-Copper-Conductive-Adhesive/dp/B07TV26465/

I'm working on a document / series of posts about coronavirus biology – viral structure, replication cycle, that sort of thing. This is mostly for my own education but I figure it's also a useful exercise to make the result public in a presentable form. I'm posting this here (a) as a commitment device to get something out in the next week or so, and (b) to see if anyone has any questions they'd like answered in this area that I could look into.

Currently I'm mainly learning about coronavirus biology in general, expect to switch to COVID19 specifically in a couple of days.

Is COVID really helping the environment? Some articles suggest there's a postive short term impact from lower air pollution, but when I looked at long term CO2 in the atmosphere there's been no impact. Would be interested in thoughts? Blog here: https://www.thendobetter.com/investing/2020/3/12/no-impact-seen-on-atmospheric-co2-in-q1-2020

Edit: apparently the cited study does say that no viable SARS-COV-2 virus was found on the copper after 4 hours.

Original comment:

Dr. Peter Hotez said on the podcast The Drive (https://peterattiamd.com/peterhotez/) that a new (March 13) paper (https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v2) found that SARS-COV-2 could last for 8-24 hours on copper. If you search for "copper" in the show notes you'll find the 8-24 hour figure.

Is it possible to quickly develop (within 24h) respiratory failure or breathing difficulties without having severe onset symptoms (i. e. fever, perhaps chest pain (chest congestion) or unstoppable cough)? Which symptoms exactly should be looked out for? If the possibility of suddenly going straight to blue is unavoidable, what is the distribution of how exactly physically able and mentally coherent you are likely to become when that happens?

(personalized: There's a considerable probability I'm already infected and my isolated space is located in a rather obscure place which is about 1.5km from the nearest road where ambulance can adequately reach me. I need a clear-cut line for when I should orderly organize for me to be transported back to civilization. If this line is not reliable or something goes very wrong, how likely it is that I would be able to walk 1.5km in emergency condition, with -10 Celsius outside, all by myself?)

Drive through screening test? Would they be good for the USA and EU?

Just looked at a link for a Vox article that popped up when I launched my browser. Nice chart but would be interesting to know some thing about the model parameters (and I think the graph is illustrative not anything factual or based on some model CDC has) that would be required to achieve the image, and some sense about how close both USA and EU are to achieving the parameter values.

I thought the interesting thing about is was that the goal is not really about reducing the number of infections. That is not really a narrative that is in the public media at this time -- or I'm missing it.

Take someone in the U.S. who is heavily immunocompromised, such that their risk of death from any infection beyond a mild cold averages to 15%, and assume that their risk of death from coronavirus is 100%. Assume they've been employing social distancing tactics as a result for some time.

Is there available information or projections on whether the total risk for this person has increased or decreased as a result of coronavirus?

A key assumption/the reason it may have decreased is that we could expect that the prevalence of all other diseases is falling due to the social distancing tactics being employed for coronavirus.

1) are we going to create some super-bacteria by using a ton of hand sanitizer and wipes?

2) Is this report of 40-70% infection rate world-wide reputable, realistic, useful?

https://thehill.com/changing-america/well-being/prevention-cures/482794-officials-say-the-cdc-is-preparing-for

In my view we don't know what percentage of infections result in a) symptoms, b) serious symptoms. It's pretty easy to take those estimates coupled with current death rates and get a result of 100million deaths due to COVID-19. That seems super extreme and unlikely to me.

I'm not sure the usefulness of stating a 40-70% infection rate if the rate of critical symptoms within that group is only ~10%

CROSSPOST from my blog:

https://protokol2020.wordpress.com/2020/03/27/covid-19-a-view-to-a-kill

The R0 factor for this illness, which denotes the average number of people infected by a carrier, isn't a constant, it's a function of time. R0 = R0 (time). In fact, it's a function of more parameters and not just time. For example, if quarantined, R0 should be close to 0. There are many unknown factors here, of course, some even known. Some push this now well known R0 term bellow 1, others above 1. It's all about reducing R0 below 1, and the illness will die out. Otherwise, the number of sick people will go through the roof, by the exponential growth function manner.

All of the above is very well known and understood and repeated over and over again now.

Then you get infected, you caught the virus somehow, what now? Your cells will spread the virus among each other by the factor R0IC !

R0IC is the average number of cells, one infected cell will further infect on average. "IC" in standing for "Inter-Cellular". This is again not a constant but is a function of time and many other known and unknown factors. For example time, temperature, the immune system activity and so on. R0IC = R0IC (t, T, ISactivity, ..., ). At least as complex as the transmission factor R0 between humans, is the transmission factor R0IC between cells. When R0 falls bellow 1 for a considerable time period, the epidemics burn out. When R0IC  falls bellow 1 for a considerable time period, the particular human's illness burns out.

The last paragraph above is a less well-known fact, but it's a fact none the less. Spreading of this virus among cells, in a way closely imitates the spreading among humans. Medical doctors and medical nurses work hard to minimize R0IC in already infected people. They might call it differently, but it is what it is. Stoping the intercellular infection, "flattening the curve" inside the patient's body, "delaying the disease" inside the patient's lungs -- you name it!  Medical professionals thus "delay the disease" inside you, hoping that the immune system will kick in and do the same until done.

Now, when you are infected and breath, you inhale more or less clean air and exhale quite a lot of viruses. Soon, you are inhaling some previously exhaled viruses back and some of those might infect an additional lung cell.  By breathing through SCUBA, there are no previously exhaled viruses and therefore this R0IC should go down slightly, shouldn't it? By breathing some higher oxygen concentrations than normal, this R0IC should go down even more. Since oxygen is a bit toxic for COVID-19.

By breathing some WARMER air than normal, this R0IC should go down even more, since the COVID-19 virus doesn't like hot air, does it? Especially if the air is salty or smells of some detergent, pure alcohol and so on, it's killing the viruses. Some even inside your nose and downward, perhaps.

Then, you may, sometimes after infection, during the asymptomatic phase, run up the hill in sunny weather. Puffing like an old locomotive, you will exhale a lot of viruses. Fortunately, nobody is with you and those exhaled viruses will die under the Sun. Again, you even so slightly decreased the R0IC factor and "flattened the curve" of the internal infection between your cells. You may as well try to inhale some eucalyptus hot vapors under the towel, as they suggest already. Perhaps you should insulate yourself in a sauna. Not too hot, not too humid, but just enough for you to survive and not the virus. Under medical control, of course!

And then perhaps, medical doctors should think about their doctrinal procedures for COVID-19 in this light and to refine these suggestions above considerably. I am no medical doctor! But then again, Marylin Vos Savant was no mathematician either but gave a valuable lesson to Paul Erdos himself. There are times when IQ matters the most.

Anyway. When and if you are infected with COVID-19, in the presymptomatic phase, keep the R0IC down as much as you possibly can. The second symptomatic phase may never come. Doing so, you will (ever so slightly) lower the R0 too!

DISCLAIMER: This is not official medical advice, not even unofficial medical advice. Contact your MD if or when feel ill!